Dr. Nedic explains all about dangerous estrogens…
The estrogen dilemma
It’s alarming to think that estrogen, the natural hormone circulating through our bodies which is responsible for so many functions, could, in fact, be cancer causing. Dr. Sly Nedic discusses the cause and effects Breast cancer is the most prominent cancer in South Africa, with more than 96% of it belonging to hormone-sensitive cancers (precisely: estrogen). Therefore, it’s vital to understand which estrogens are cancer enhancing.
Estrogen: Blessing or curse?
Estrogen is one of the most important hormones in a woman’s body, as its’ responsible for the stimulation of the ovaries, breasts, vagina, and uterus into maturation. Its many functions also include:
- the preparation of the uterus for fetal development,
- activating milk production in breasts,
- initiating a woman’s menstrual cycle,
- regulating part of the brain involved in sexual and reproductive functions,
- preventing arteriosclerosis,
- preserving memory and bone density,
- maintaining vaginal lubrication and thickness,
- keeping skin firm,
- immune function and interaction with other hormones in the body.
However, when estrogen is low during the menopausal period, all the above functions stop and women then desperately seek a replacement for this youth resource. Where is our estrogen coming from? Estrogen is produced in our body, primarily in the ovarian cells (during the reproductive years). There are three main types of estrogen: estradiol, estrone, and estriol. Our body produces them differently and in different phases of our life. For example, estradiol is the main hormone that occurs during the reproductive phase of a woman’s life, and it’s the main hormone that promotes the firmness and youthfulness of our skin. Meanwhile, estrone is the main menopausal hormone with a high affinity towards breast tissue receptors – and estriol is the protective estrogen. Estriol is also highly secreted during pregnancy; it competitively inhibits estradiol and inhibits the growth of breast/ ovarian cancers in animal models. One can imagine that during hormone replacement therapy, we like to give patients the youth of the estradiol in conjunction with the protection of the estriol – and ideally in the ratio that is personalized for each patient. Dangerous metabolites and forms Our body identifies our own estrogen as a toxin, so like many of the toxins entering our bodies, estrogen must also undergo detoxification in the liver. The enzymes involved in this detoxification process can vary from person to person – depending on the genes which are coding for these enzymes. Sometimes during certain phases in the detoxification process, the body produces more toxic products than the initial amount; therefore a person can create dangerous metabolites with a higher estrogenic effect. This can be responsible for initiating breast cancer. The amount and type of these dangerous metabolites will depend on each individual’s genetics. The good news is that we can modulate these gene expressions by implementing specific nutrition and lifestyle changes. In that way, we can change the amount of dangerous estrogen metabolites and use them as a tool for breast cancer prevention. There are some of these metabolites which are studied well, and women are creating them while completely unaware of what is decreasing or increasing their production.
- Good Metabolites – 2-0H estron & estradiol which are relatively cancer protective. – 2- metoxy-estron which is cancer protective
- Bad Metabolites – 4-0H estron & estradiol which are cancer enhancing and proliferative – 16α -0H estron which is cancer enhancing and proliferative
And the real cause of these good or bad metabolites (simplified) is a combination of genes and environmental factors; such as lifestyle, diet and nutrients, the presence of toxic xenoestrogens in cigarette smoke, preservatives and non-organic foods etc. There is numerous supportive literature confirming that the ratio between 2-0H and -16α -0H E1 is a risk assessment tool for hormone-sensitive cancers. “In a study of 10 786 women, it was found that the ratio of 2-OH to 16-OH estrone was a very sensitive indicator for breast cancer risk. The higher the ratio of 2:16 OH, the lower the incidence of breast cancer.” (Epidemiology 11:635-640 -2000)
Conventional hormone replacement therapy (HRT) (not Bio-identical) is a well-known risk factor for breast cancer amongst post-menopausal women. It has shown that the estradiol-based HRT used, increases the formation and urinary excretion of both 2-OHE and 16α-OH E1, which is ten-fold more (according to supportive studies).
Possible causes that result in the low 2:16α OH E1 Ratio are:
- Increased net estrogen activity in the body
- Presence of genes for high 16-α OH E2
- Hypothyroidism (low thyroid function)
- High fat, low fiber diet
- High Omega-6 fatty acids
- Pesticide exposure and smoking
- Meds: oral contraceptives and conventional HRT
- Alcohol consumption (more than one glass of wine per day)
Identifying a woman’s individual estrogen metabolism (as well as the genes involved in the detoxification of estrogen) is crucial in the prevention of breast cancer. It is also vital for the prevention of the possible prescription of Bio-identical hormone replacement, as we all have a different production of estrogen. Extensive research showed that when some of the genes involved in estrogen detoxification are present, there is an increased risk of breast cancer. One of these genes is the COMT gene. In women who produce 4-OH estrogen, higher expression of COMT is instrumental in the production of dangerous Quinones. These initiate a series of events leading to breast cancer when they react with DNA. The COMT genotype remains the most significant factor for breast cancer development and is associated with a 4-fold increase in the risk of breast cancer. COMT is part of the genetic test I perform routinely prior to prescribing bio-identical hormone replacement therapy to a patient – or it can be done for any woman that wants to understand how she metabolizes her own estrogen.
As much as we want estrogen to keep our youth and beautiful skin-intact for as long as possible, we need to identify, understand and correct the dangerous estrogens in our body. A patient’s dedication to maintaining the supplementation and undergoing lifestyle and nutritional changes that are personally prescribed to them is also crucial.
4 ways to balance estrogen?
Balancing estrogen in a woman’s body is essential for breast cancer prevention at any age – and is also vital prior to prescribe bio-identical hormone replacement. It is personalized to each woman and cannot be generalized.
The tools are:
1 Balance endogenous & exogenous estrogen input (for example: decreasing the amount of xeno-estrogens or stopping the contraceptive pill)
2 Promote a healthy ratio of good and bad estrogen metabolites (2OH-16α OH ratio with nutritional intervention and supplements (for example: taking cruciferous vegetables or I3C supplement)
3 Protect cells from dangerous estrogen metabolites if high (for example Resveratrol)
4 Promote healthy detoxification of estrogen by nutrition and supplements (for example: taking B6, B12 and methylated folic acid to enhance methylation of estrogens)